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. 2023 Nov 14;20(1):81.
doi: 10.1186/s12981-023-00568-2.

"Sex without fear": exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England

Rosalie Hayes  1 , Will Nutland  2 , Michael Rayment  3 , Sonali Wayal  4 , Vanesa Apea  5 , Amanda Clarke  6 , Alan McOwan  3 , Ann Sullivan  3 , Monica Desai  7 , Andrew Jajja  8 , Brian Rice  9 , Rob Horne  10 , Sheena McCormack  11 , Mitzy Gafos  8
Affiliations

"Sex without fear": exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England

Rosalie Hayes et al. AIDS Res Ther. .

Abstract

Gay, bisexual, and other men who have sex with men (GBMSM) experience a high prevalence of psychosocial health problems, such as harmful substance use and depression, as well as being disproportionately affected by HIV. HIV Pre-Exposure Prophylaxis (PrEP) may provide psychosocial benefits beyond its intended purpose of reducing HIV infection. We explore the psychosocial impact of oral PrEP use on gay men in England using qualitative data from the PROUD study. From February 2014 to January 2016, semi-structured in-depth interviews were conducted with 40 gay men and one trans woman. Participants were purposively recruited based on trial arm allocation, adherence, and sexual risk behaviours. By removing HIV risk from sex, PrEP improves users' wellbeing by reducing HIV-related anxiety and internalised stigma and increasing HIV prevention self-efficacy, sexual pleasure, and intimacy. In turn, these psychological changes may influence behaviour in the form of greater sexual freedom, reduced harmful drug use, and more protective sexual health behaviours. However, PrEP may create internal conflict for some gay men, due to its disruption of social norms around condom use and its perceived influence on their sexual behaviour leading to reduced condom self-efficacy. These findings provide a baseline of PrEP's psychosocial impact amongst some of the first PrEP users in England and supports calls to consider the psychosocial impact of PrEP in prescribing guidelines.

Keywords: Gay bisexual and other men who have sex with men; HIV prevention; Pre-exposure prophylaxis; Psychosocial impact; Sexual anxiety.

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Conflict of interest statement

The PROUD study provided drug free of charge by Gilead Sciences plc. which also distributed it to participating clinics and provided funds for additional diagnostic tests for HCV and drug levels. SMc reports grants from the European Union H2020 scheme, EDCTP 2, the National Institute of Health Research, and Gilead Sciences; other support from Gilead Sciences, and the Population Council Microbicide Advisory Board; and is Chair of the Project Advisory Committee for USAID grant awarded to CONRAD to develop tenofovir-based products for use by women (non-financial). AS’s organisation has received Gilead fellowships in the past. The remaining authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Purposeful selection of participants for IDIs based on trial arm allocation, risk behaviour and adherence * One participant co-enrolled and in the main trial analysis is treated as being in the deferred arm to which they were originally allocated. However, they are treated as being in the immediate arm here as this was how they were selected for IDI ** Additional interviews were conducted with a trans woman, a person who seroconverted during the study, and a participant who decided not to start PrEP after the deferral period
Fig. 2
Fig. 2
Psychosocial impact of oral PrEP use among PROUD participants
See this image and copyright information in PMC

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